Making decisions about treatment for localized prostate cancer

Objective To describe the decision-making processes used by men diagnosed with localized prostate cancer who were considering treatment. Patients and methods Men newly diagnosed with localized prostate cancer from outpatient urology clinics and urologist's private practices were approached before treatment. Their decision-making processes and information-seeking behaviour was assessed; demographic information was also obtained. Results Of 119 men approached, 108 (90%) were interviewed; 91% reported non-systematic decision processes, with deferral to the doctor, positive and negative recollections of others' cancer experiences, and the pre-existing belief that surgery is a better cancer treatment being most common. For systematic information processing the mean (SD, range) number of items considered was 4.19 (2.28, 0-11), with 57% of men considering four or fewer treatment/medical aspects of prostate cancer. Men most commonly considered cancer stage (59%), urinary incontinence (55%) and impotence (51%) after surgery, and low overall mortality (45%). Uncertainty about probabilities for cure was reported by 43% of men and fear of cancer spread by 37%. Men also described uncertainty about the probabilities of side-effects (27%), decisional uncertainty (25%) and anticipated decisional regret (18%). Overall, 73% of men sought information about prostate cancer from external sources, most commonly the Internet, followed by family and friends. Conclusions In general, men did not use information about medical treatments comprehensively or systematically when making treatment decisions, and their processing of medical information was biased by their previous beliefs about cancer and health. These findings have implications for the provision of informational and decisional support to men considering prostate cancer treatment.

Negative ion electrospray mass spectra of caerulein peptides: an aid to structural determination

MS/MS data derived from the [M-H](-) ions of desulfated caerulein peptides provide (i) sequencing information from a combination of alpha, beta and gamma backbone cleavages, and (ii) identification of specific amino acid side chains by side-chain cleavages [e.g. Ser (-CH2O), Thr (-CH3CHO) and Asp (-H2O)] (fragmentations having no counterparts in positive ion spectra). In addition, delta and/or gamma backbone cleavage ions from Asp residues identify the position of these residues in the peptide. In contrast, neither delta nor gamma cleavage ions are observed from either the Gln2 residue nor from Phe residues. Full structural information can be obtained from a consideration of the positive and negative ion MS/MS data in concert. Copyright (C) 2002 John Wiley Sons, Ltd.

Knowledge of the national emergency telephone number and prevalence and characteristics of those trained in CPR in Queensland: baseline information for targeted training interventions

Members of the community contribute to survival from out-of-hospital cardiac arrest by contacting emergency medical services and performing cardiopulmonary resuscitation (CPR) prior to the arrival of an ambulance. In Australia there is a paucity of information of the extent that community members know the emergency telephone number and are trained in CPR. A survey of Queensland adults (n = 4490) was conducted to ascertain current knowledge and training levels and to target CPR training. Although most respondents (88.3%) could state the Australian emergency telephone number correctly, significant age differences were apparent (P < 0.001). One in five respondents aged 60 years and older could not state the emergency number correctly. While just over half the respondents (53.9%) had completed some form of CPR training, only 12.1% had recent training. Older people were more likely to have never had CPR training than young adults. Additional demographic and socio-economic differences were found between those never trained in CPR and those who were. The results emphasise the need to increase CPR training in those aged 40 and over, particularly females, and to increase the awareness of the emergency telephone number amongst older people. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

The therapeutic potential of dopamine modulators on the cardiovascular and renal systems

In the periphery, physiological dopamine increases renal blood flow, decreases renal resistance and acts on the kidney tubule to enhance natriuresis and diuresis. The loss of dopamine function may be involoved in the deterioration in kidney function associated with ageing and may have a role in the pathogenesis of hypertension and diabetes. Intravenous dopamine is used as a positive inotrope in the treatment of acute heart failure and cardiogenic shock and as a diuretic in renal failure. The clinical uses of dopamine are limited, as it must be given intravenously, and also has widespread effects. The levels of peripheral dopamine can be increased by the administration of L-dopa to increase synthesis, prodrugs to release dopamine (docarpamine, glu-dopa) or by inhibiting the breakdown of dopamine (nitecapone). Preliminary clinical trials suggest that docarpamine may be useful in patients with low cardiac output syndrome after cardiac surgery and in refractory cirrhotic ascites. Ibopamine is an agonist at dopamine D1 and D2 receptors, which may retard the progression of chronic renal failure. Gludopa is selective for the kidney thus avoiding widespread side effects. The early clinical studies with ibopamine as a diuretic in heart failure were favourable but the subsequent large mortality study showed that ibopamine increased mortality. Fenoldopam is a selective dopamine D1 receptor agonist. Intravenous fenoldopam may be useful in the treatment of hypertension associated with coronary artery bypass surgery or in hypertensive emergencies. Although our understanding of physiological and pathological roles of peripheral dopamine has been increasing rapidly in recent times, we still need more information to allow the design of clinically useful drugs that modify these roles. One priority is an orally-active selective dopamine D1 receptor agonist.

Evidence and information for health policy: a decade of change

Over the past decade or so, there has been increasing demand for greater clarity about the major causes of disease and injury, how these differentially affect populations, and how they are changing. In part, this demand has been motivated by resource constraints and a realisation that better health is possible with more informed allocation of resources. At the same time, there has been a change in the way population health and its determinants are quantified, with a much closer integration of the quantitative population sciences (such as epidemiology, demography and health economics) to strengthen and broaden the evidence base for healthcare policy.

Researchers' information needs in the bibliographic database : a literature review

This article is published online with Open Access and distributed under the terms of the Creative Commons Attribution Non-Commercial License.

Estudo da camada limite atmosférica em regiões metropolitanas costeiras com simulações de brisa marítima

O principal objetivo deste trabalho foi identificar e caracterizar a evolução diária da Camada Limite Atmosférica (CLA) na Região da Grande Vitória (RGV), Estado do Espírito Santo, Brasil e na Região de Dunkerque (RD), Departamento Nord Pas-de-Calais, França, avaliando a acurácia de parametrizações usadas no modelo meteorológico Weather Research and Forecasting (WRF) em detectar a formação e atributos da Camada Limite Interna (CLI) que é formada pelas brisas marítimas. A RGV tem relevo complexo, em uma região costeira de topografia acidentada e uma cadeia de montanhas paralela à costa. A RD tem relevo simples, em uma região costeira com pequenas ondulações que não chegam a ultrapassar 150 metros, ao longo do domínio de estudos. Para avaliar os resultados dos prognósticos feitos pelo modelo, foram utilizados os resultados de duas campanhas: uma realizada na cidade de Dunkerque, no norte da França, em Julho de 2009, utilizando um sistema light detection and ranging (LIDAR), um sonic detection and ranging (SODAR) e dados de uma estação meteorológica de superfície (EMS); outra realizada na cidade de Vitória – Espírito Santo, no mês de julho de 2012, também usando um LIDAR, um SODAR e dados de uma EMS. Foram realizadas simulações usando três esquemas de parametrizações para a CLA, dois de fechamento não local, Yonsei University (YSU) e Asymmetric Convective Model 2 (ACM2) e um de fechamento local, Mellor Yamada Janjic (MYJ) e dois esquemas de camada superficial do solo (CLS), Rapid Update Cycle (RUC) e Noah. Tanto para a RGV quanto para a RD, foram feitas simulações com as seis possíveis combinações das três parametrizações de CLA e as duas de CLS, para os períodos em que foram feitas as campanhas, usando quatro domínios aninhados, sendo os três maiores quadrados com dimensões laterais de 1863 km, 891 km e 297 km, grades de 27 km, 9 km e 3 km, respectivamente, e o domínio de estudo, com dimensões de 81 km na direção Norte-Sul e 63 km na Leste-Oeste, grade de 1 km, com 55 níveis verticais, até um máximo de, aproximadamente, 13.400 m, mais concentrados próximos ao solo. Os resultados deste trabalho mostraram que: a) dependendo da configuração adotada, o esforço computacional pode aumentar demasiadamente, sem que ocorra um grande aumento na acurácia dos resultados; b) para a RD, a simulação usando o conjunto de parametrizações MYJ para a CLA com a parametrização Noah produziu a melhor estimativa captando os fenômenos da CLI. As simulações usando as parametrizações ACM2 e YSU inferiram a entrada da brisa com atraso de até três horas; c) para a RGV, a simulação que usou as parametrizações YSU para a CLA em conjunto com a parametrização Noah para CLS foi a que conseguiu fazer melhores inferências sobre a CLI. Esses resultados sugerem a necessidade de avaliações prévias do esforço computacional necessário para determinadas configurações, e sobre a acurácia de conjuntos de parametrizações específicos para cada região pesquisada. As diferenças estão associadas com a capacidade das diferentes parametrizações em captar as informações superficiais provenientes das informações globais, essenciais para determinar a intensidade de mistura turbulenta vertical e temperatura superficial do solo, sugerindo que uma melhor representação do uso de solo é fundamental para melhorar as estimativas sobre a CLI e demais parâmetros usados por modelos de dispersão de poluentes atmosféricos.